Wednesday, April 6, 2016

Chiropractic Manipulative Treatment: Duplicate Denials

Denial Reason, Reason/Remark Code(s) 

CO-18 - Duplicate Service(s): Same service submitted for the same patient, same date of service by
same doctor will be denied as a duplicate
CPT codes: 98940, 98941, 98942

Resolution/Resources
First: Verify the status of your claim before resubmitting. You can determine the status of a claim through the Palmetto GBA Online Provider Services (OPS) tool or by calling the Palmetto GBA Interactive Voice Response (IVR) unit.

Online Claim Status Verification through OPS 

All providers that have an EDI Enrollment Agreement on file may register to use this tool. If you haven’t already registered, please consider doing so.

Access the introductory article to learn more by selecting the 'Introducing Online Provider Services' graphic on the top of any of our main contract Web pages

Please note: Only one provider administrator per EDI Enrollment Agreement/per PTAN/NPI combination performs the registration process. The provider administrator can then grant permission to additional users related to that PTAN/NPI.

Billing services and clearinghouses should contact their provider clients to gain access to the system
Specific instructions for accessing claim status information through OPS are available in the OPS User Manual.

Please note:
Only one chiropractic manipulative treatment will be allowed per day

Beneficiary Eligibility Denials

Denial Reason, Reason/Remark Code(s)
PR-26: Expenses incurred prior to coverage
PR-27: Expenses incurred after coverage terminated

Resolution/Resources: Verify patient eligibility prior to submitting claims to Medicare through the Palmetto GBA Online Provider Services (OPS) tool or Interactive Voice Response (IVR) unit.

Online Eligibility Verification through OPS

All providers that have an EDI Enrollment Agreement on file may register to use this tool. If you haven't already registered, please consider doing so.

Access the introductory article to learn more by selecting the 'Introducing Online Provider Services' graphic on the top of any of our main state Web pages

Please note: Only one provider administrator per EDI Enrollment Agreement/per PTAN/NPI combination performs the registration process. The provider administrator can then grant permission to additional users related to that PTAN/NPI.

Billing services and clearinghouses should contact their provider clients to gain access to the system
Specific instructions for accessing beneficiary eligibility information through OPS are available in the OPS User Manual

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